Worksheet for Determining Pattern Behavior Directions - Tuscola ...

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WORKSHEET FOR DETERMININGA PATTERN OF BEHAVIORDIRECTIONS FOR COMPLETINGDESCRIPTION OF BEHAVIOR/INCIDENTSUBJECT TO DISCIPLINEList all incidents subject to disciplinary removalfor current school year.Date ofSuspensionNumber ofdays ofsuspensionCumulativedays ofsuspensionProximityofremovalsIncident #1 x xIncident #2Incident #3Incident #4Incident #5Incident #6Incident #7Guidance: Use this chart to keep a running record of the student’s suspensions. By completing the chartfor each incident, the team will be able to see all of the behaviors subject to suspension as well as thenumber of days of removal, the proximity of removals, and cumulative days of removal.The first column requires a description of the behavior and incident subject to discipline. The incidentshould be described in enough detail so that the team can look at the connection between the behavior ofthe student in the current incident and previous incidents. Important statements to include, whenavailable: activities that went on before the incident; precipitating event; other people involved;statements made by the student and others before, during, and after the incident; location and time ofthe incident.The second column is the date of the current suspension.The third column is the number of days in the current suspension.The fourth column is the cumulative number of days of suspension, including the current number ofdays of removal.The fifth column would specify the proximity of removals, detailing the number of days, weeks, ormonths since the last incident.Michigan Department of Education, Office of Special Education Services and Early Intervention Services
WORKSHEET FOR DETERMININGA PATTERN OF BEHAVIORDIRECTIONS FOR COMPLETINGDETERMINATION OF PATTERNOF REMOVALSRATIONALE FOR DETERMINATIONIncident #1Incident #2Incident #3Incident #4Incident #5Incident #6Incident #7YesNoYesNoYesNoYesNoYesNoYesNoYesNoGuidance: Use this chart to record the decision of the team regarding whether there is a pattern ofremovals.The first column references an incident in the first column of the previous chart (Description ofBehavior). The conclusion of the team in incident #1 would be recorded in the first column of this chart(Determination of Pattern) in the cell labeled Incident #1, and so forth for each incident.The second column would document the explanation for the team’s decision regarding the pattern ofremovals. The cell next to Incident #1 is shaded since a pattern would only be observed after the secondincident.Michigan Department of Education, Office of Special Education Services and Early Intervention Services
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